Reviewing a client's medical record before the interview helps nurses tailor questions and build rapport.

Understanding when to review a client’s medical record during an interview is one of those little crossroads that can shape the whole assessment. It seems simple, but it quietly changes how you listen, what you ask, and how you show up with the patient. If you’re studying ATI Physical Assessment concepts, you’ve probably encountered questions like this one: When should a nurse review a client’s medical record during the interview? A. Before the interview begins B. During the interview C. At the conclusion of the interview D. Only if the client requests it. The official answer on many teaching guides is “at the conclusion of the interview.” But there’s a bit more texture to the story, and that nuance matters in real life.

Let me explain the nuance first. The exam might point to the conclusion because it’s testing whether you’re paying attention to patient autonomy and interview etiquette. The idea is to avoid biasing the patient’s responses and to ensure you’re not interrupting the flow of conversation. It’s a valid point in the abstract, and on a test, it helps to pick the option that aligns with certain ethical or procedural framings. Yet, in day-to-day clinical work, many nurses find it more practical—and more effective—to review the medical record before the interview starts. Here’s why that balance matters.

Why reviewing before can be a game-changer

• You walk in with context, not guesses. A quick skim of the patient’s health history, current medications, allergies, and recent hospitalizations gives you a map. You’re not firing in the dark; you’re following a trail that leads to more meaningful conversations.

• You tailor questions on the fly. If you know a patient has hypertension, you’re likely to ask about blood pressure trends, medication adherence, and recent symptoms that might reflect cardiovascular strain. If you see a history of liver disease, you’ll approach medication reconciliation with extra care. This kind of targeted interviewing makes the exchange feel collaborative rather than interrogatory.

• You catch red flags early. Allergies that haven’t been communicated, polypharmacy risks, or recent changes in treatment plans—these are easier to spot when you’ve reviewed the chart ahead of time. It reduces the chance of missing something crucial because you didn’t know what to ask about.

• You build rapport with competence. Patients notice when you seem prepared. A nurse who can reference a medication list or a recent lab result during a first contact tends to convey confidence and care. That translates into trust, which is the foundation of any thorough assessment.

• You protect patient safety. Ensuring you’re aware of drug interactions or contraindications before discussing treatment options with the patient isn’t just efficient; it’s safer. It’s hard to juggle new information without a baseline.

A practical way to approach it

If you’re leaning toward reviewing before the interview, here’s a straightforward approach you can adapt:

• Quick glance strategy (2–4 minutes). Open the EHR, scan the latest problem list, active medications, allergies, recent vital signs, and the last major treatments or procedures. Skip the long narrative unless something jumps out.

• Note-taking that sticks. Jot a tiny checklist: allergies, current meds, significant diagnoses, prior surgeries, and recent labs that might influence current symptoms. You’re not rewriting history; you’re anchoring the conversation.

• Plan your questions. Based on what you saw, map 3–5 open-ended questions to explore current concerns, with one or two targeted prompts ready if a red flag appears.

• Privacy and respect. Always consider the patient’s privacy. If you’re in a shared space, make sure others aren’t listening to sensitive details. A quick heads-up to the patient that you’ll review their chart helps set expectations.

A word on the “during the interview” option

Now, what about the idea of reviewing during the interview? There are times when you might end up cross-checking as you go. Maybe something in the patient’s statements triggers you to pull up a chart note, or a new symptom emerges that requires a quick look at recent lab trends. In practice, this can be useful to clarify or verify something that arises in real time. The risk, though, is that it can interrupt the narrative flow, pull the patient into a back-and-forth about documentation, and risk omitting a tangent that matters to the patient’s experience.

When you might choose to review during the interview, it’s usually to verify new information that occurs in the moment—say a patient mentions a medication change or an adverse reaction that you want to confirm against the record. If you do this, explain briefly what you’re doing and why. A simple, “I just want to confirm this in your chart so I can understand your current meds accurately” goes a long way toward preserving trust while you verify details.

At the conclusion: a moment to clarify and confirm

So why does the exam item say “at the conclusion”? The logic is straightforward: you allow the patient to share their story without interruption, and then you verify any inconsistencies or missing elements against the chart as a closing step. This approach respects the patient’s autonomy and avoids steering the conversation with preloaded assumptions. It also provides a clean, final moment to align what you heard with what’s in the record, ensuring you’ve captured the patient’s narrative and the chart’s facts in tandem.

But here’s another truth: most clinicians find that a short, targeted pre-interview review makes the closing alignment even smoother. You don’t have to choose one universal method. You can adopt a hybrid approach that suits the setting, the patient, and the clinical goal.

Practical tips for a smooth, patient-centered interview

• Start with the patient, then confirm with the record. Open with neutral, open-ended questions about the patient’s current concerns. Then, using the chart you reviewed beforehand, you can narrow down, confirm, and clarify specifics.

• Use the chart as a guide, not a script. The chart is a map, not the entire terrain. Let your patient’s story be the main road, and the record your signposts that help you navigate important side streets.

• Balance speed with depth. A brisk 2–3 minute pre-review can pay off in longer, more meaningful dialogues. You don’t want to turn the interview into a rapid-fire checklist; you want to illuminate nuances.

• Be mindful of biases. If you’ve reviewed the chart, you might be tempted to steer questions in a certain direction. Stay curious. Let the patient’s experiences shape the conversation while you’re still informed by the chart.

• Protect privacy and consent. If you’re in a shared space or there are sensitive records, secure permission to review notes and keep discussions within hearing distance appropriate to the setting.

Beyond the practical: human factors that sometimes slip under the radar

• The patient’s story matters more than the record alone. A chart can tell you what happened; the patient tells you how it felt and what it means to them now. A compassionate interview honors both perspectives.

• Cultural and language considerations. If you’re working with someone from a different cultural background, take a moment to acknowledge how health beliefs and communication styles might shape what they share. A respectful stance helps the conversation stay two-sided and honest.

• Emotional tone matters. Some patients walk in carrying fear, anxiety, or resignation. Your readiness to listen, validate feelings, and respond with clarity helps reduce stress and makes it easier for them to disclose information that isn’t obvious in the chart.

Putting it all together: what to take away

• The exam-style takeaway: the safest, cleanest answer for the question framed is “at the conclusion.” This reflects a respect-for-autonomy stance and ensures you’re not prompting or biasing the patient prematurely.

• The real-world takeaway: many nurses benefit from a brief review before the interview. It sharpens questions, prevents missing critical details, and helps you connect with the patient right from the start.

• The flexible rule: if you’re in a setting where you can review beforehand without breaking patient trust or privacy, do it. If the environment is urgent or privacy is tight, you may lean toward a concise pre-review followed by a careful, patient-led dialogue, then a final chart check as you conclude.

A final thought for your learning journey

Think of the interview as a collaborative story you’re helping the patient tell. The chart is a companion to that story, not its author. When you approach the interview with a light pre-session scan, you’re better prepared to listen deeply, ask the right questions, and address what truly matters. If you’re ever unsure which path to take, prioritize patient safety, respect, and clarity. The record will still be there to confirm details, but the patient’s voice is the heart of the assessment.

If you’re navigating ATI material and you want a clear, practical sense of how these decisions play out in real clinical settings, you’re not alone. Many nurses keep a mental checklist handy: what to review, what to ask, and how to wrap up so the patient feels heard and cared for. It’s a small set of habits, but it makes a big difference in the quality of the assessment—and in the patient’s experience along the way.